End-to-End Workflow Automation for CMS IDR

Centralized IDR Dashboard

Get complete visibility into your entire IDR portfolio from a single, intuitive dashboard. Track claims at every stage of the dispute resolution process, monitor deadlines, and identify high-priority cases requiring immediate attention.

• Claim Intake & Classification: Automatically import and categorize out-of-network claims from your billing system
• Eligibility Determination: AI-powered analysis identifies which claims are viable for IDR based on federal guidelines and historical data
• Smart Prioritization: Machine learning algorithms rank cases by potential recovery value and likelihood of success
• Deadline Management: Never miss a critical filing window with automated countdown timers and notifications

Automated IDR Advocacy Document Generation

Transform hours of manual document preparation into minutes with AI-powered advocacy generation. Arbitrus Task Manager analyzes claim details, clinical information, and relevant statutory factors to produce compelling, well-structured advocacy documents that maximize your recovery potential.

How It Works:

• Automated Data Extraction: Pull relevant clinical codes, service details, and patient information directly from your EMR and billing systems
• Statutory Factor Analysis: AI evaluates all 45 CFR 149.510 factors including complexity of service, patient acuity, provider experience, market conditions, and contractual terms
• Compelling Narrative Generation: Natural language processing creates professional, persuasive advocacy statements tailored to each claim's unique circumstances
• Evidence Compilation: Automatically gather and organize supporting documentation including clinical notes, fee schedules, and market data
• Human Review Layer: Optional expert review available for high-value or complex cases before submission

Accounting Notification Workflow

Ensure seamless coordination between your revenue cycle and IDR teams with automated accounting notifications. Keep finance teams informed of claim status changes, payment expectations, and required actions throughout the dispute resolution lifecycle.

Automated Notification Triggers:

• IDR Initiation Alerts: Notify accounting when claims enter the federal IDR process, with estimated timeline and potential recovery amounts
• Status Change Updates: Real-time notifications when claims move through negotiation, arbitration, and determination phases
• Payment Expectation Reports: Automatically calculate and communicate expected payment amounts based on determination outcomes
• Collection Action Holds: Flag accounts to prevent conflicting collection activities during active IDR proceedings
• Reconciliation Requests: Trigger accounting review when payments are received or discrepancies are identified

Accounting Dashboard

Provide your finance team with dedicated tools for tracking IDR-related revenue, managing accounts receivable, and reconciling payments. The Accounting Dashboard translates complex dispute data into actionable financial insights.

Financial Management Features:

• A/R Aging by IDR Status: Track outstanding claims segmented by dispute phase and expected resolution timeline
• Recovery Projections: AI-powered forecasting of likely determination amounts based on historical patterns and claim characteristics
• Payment Reconciliation Tools: Match incoming payments to expected IDR determination amounts and flag discrepancies
• Revenue Recognition Guidance: Recommendations for appropriate revenue recognition timing based on claim status and confidence levels
• Bad Debt Prevention: Identify claims at risk of aging out or losing appeal rights before collections can proceed
• Audit Trail: Complete documentation of all status changes, notifications sent, and actions taken for compliance purposes

Offer History Analytics

Leverage comprehensive historical data to optimize your negotiation strategy and predict arbitration outcomes. The Offer History Analytics module transforms past IDR results into actionable intelligence for future disputes.

Multi-Dimensional Analytics:

Strategic Insights:

• Payer Behavior Analysis: Identify patterns in how specific payers negotiate and settle disputes across different service types and claim amounts
• IDR Entity Performance: Track which certified IDR entities tend to rule favorably for providers vs. payers, and adjust entity selection strategy accordingly
• Optimal Offer Determination: Machine learning models recommend initial offer amounts that maximize recovery while minimizing arbitration costs
• Settlement Probability Scoring: Predict likelihood of settlement during the 30-day open negotiation period based on claim characteristics
• Service Line Benchmarking: Compare your IDR performance across specialties and service types to identify opportunities for improvement
• Temporal Trend Analysis: Monitor how payer behavior and determination patterns evolve over time in response to regulatory changes

Data Visualization:

Payment Reconciliation & Follow-Up

Close the loop on your IDR cases with automated payment tracking, variance analysis, and systematic follow-up on outstanding determinations. Ensure every dollar owed is collected and properly reconciled.

End-to-End Payment Management:

• Determination Tracking: Monitor all IDR determinations and automatically create expected payment records in your billing system
• Payment Matching: Intelligent algorithms match incoming payments to specific IDR determinations, even when remittance information is incomplete
• Variance Investigation: Flag discrepancies between determined amounts and actual payments received, triggering review workflows
• Systematic Follow-Up: Automated escalation procedures for unpaid determinations, with customizable timelines and notification rules
• Appeal Management: Track deadlines for challenging IDR determinations and coordinate appeal processes when appropriate
• Final Resolution Documentation: Comprehensive audit trail from claim initiation through final payment and account closure